Most Southern states voted heavily against President Barack Obama in two elections, and their representatives oppose his Affordable Care Act, but paradoxically, rural areas could stand to gain the most from Obamacare’s implementation. Kentucky, for example, leads the nation in cancer death rates, but has the chance for major improvements under the ACA.

As of this week, reports the Los Angeles Times, more than 60,000 of Kentucky’s 640,000 uninsured residents (roughly one in six Kentuckians) have successfully signed up for health insurance using the state’s online marketplace, which has worked without a hitch -- unlike in other states -- since it was introduced. This has been a significant boon for Kentucky’s rural poor, many of whom have never had health insurance, and who now have the chance for life-changing medical care for the first time.

In Kentucky’s Breathitt County, poverty is the norm. For decades, coal mining provided jobs in the area, but as the industry stagnated in the 1980s, jobs became scarce and the area has not recovered. Income growth has stagnated over the past decade, and more than half of households get by on less than $20,000 per year. Per-capita income stands at just $16,000, and the rate of diabetes and health problems has led to the nickname “Coronary Valley.” Obamacare can’t solve all of Breathitt County’s problems, but it’s starting to help alleviate the burden.

The Washington Post has detailed the stories of residents’ joy at receiving coverage, through the eyes of Courtney Lively, a woman who's helping enroll Breathitt County residents in their new health care plans. One man, 52-year-old Jeff Fletcher, watched his mother and four siblings die from lung cancer and has ignored a black spot on his own lungs for years, unable to pay for any more trips to the doctor. When he learned that he qualified for a new health insurance plan, he clapped and slapped his hands on the table.

“Woo-hoo! I can go to the doctor now?” he asked. “I’m serious. I need to go.”

Starting January 2014, he can. Other stories are similar. Men and women living in poverty in Kentucky are elated to learn that they finally qualify for coverage. Not surprisingly, Lively avoids using the word “Obamacare” when explaining their new plans to Breathitt County residents, but some who catch on don’t mind.

“Well, thank God,” one man said. “I believe I’m going to be a Democrat.”

Much of the credit for rural Kentucky’s makeover goes to Gov. Steve Beshear. Beshear, a Democrat and the only Southern governor to expand Medicaid eligibility, doesn’t just see Obamacare as a way to beef up health coverage for one of America’s poorest, sickest states -- he believes the law could completely transform Kentucky in the coming years.

"I knew if I was going to make a huge difference in the health status of Kentucky, it was going to take some kind of transformational tool to do that, and that's what the Affordable Care Act is for me," Beshear told the LA Times in an interview. "I think we've started something here, that a generation from now you'll see a very different Kentucky than what you see today."

While the Affordable Care Act has the potential to transform rural Kentucky, many other Southern states may not have that opportunity at all. The Bluegrass State was the only one in the South to approve the act’s expansion of Medicaid eligibility and open a statewide health care marketplace. In the other Southern states -- most of which have Republican governors -- the refusal to expand Medicaid could have drastic consequences for their rural and working poor.

As the Kaiser Family Foundation reports, the Medicaid expansion raises income levels eligible for Medicaid to 138 percent of the poverty line, offering cover to adults who previously earned too much for Medicaid but not enough for marketplace tax credits. In the 25 states that did not expand Medicaid availability, some 5 million uninsured adults are set to fall into such a “coverage gap.”

As a direct result of Beshear’s expansion of Medicaid requirements, he estimates that 308,000 Kentuckians are now eligible for coverage under the program, while the majority of those who are still uninsured will have access to insurance discounts based on their income. Despite the gains Obamacare has brought the state, Kentucky Republicans like Senate Minority Leader Mitch McConnell, Sen. Rand Paul and the House delegation have actively opposed the Affordable Care And plan to continue opposing it throughout 2014. Beshear has just one message for them.

“Get over it,” Beshear wrote in a New York Times op-ed, “and get out of the way so I can help my people. Here in Kentucky, we cannot afford to waste another day or another life.”